This blog is devoted to bringing you information about sports injuries and health. The best part about it is it's all research based. Half my blogs posted are geared towards patients and the average person who may have questions. The other half of my blogs is geared towards those professionals in the field. Research is discussed ect.
Dr. Wayne Button

Wednesday, November 18, 2009

Carpal Tunnel Syndrome a real pain in the neck?

Often in school when we are thought the nervous system our instructors will use pretty pictures from text books. Blue represents the L5 dermatological distribution or pink is where the median nerve travels. Although these pictures give great insight towards mapping out the nervous system they can at times be diagnostically useless. This is because they are based on the belief every nerve carries out the exact same pattern in every person. In addition, it is wrong to believe every nerve which obtains a pathology will present with similar symptoms consistently.

The nervous system is one of the most complex systems the body has to offer. Studies have shown Ulnar Nerve abnormalities in patients with Carpal Tunnel Syndrome (CTS), which is a condition involving the Median Nerve.[1] Furthermore, studies have also demonstrated a decrease in pressure of the Guyon's canal (a common site for Ulnar nerve entrapment) after Carpal Tunnel surgeries have been performed.[2]

This gives premise to the concept that nerves in one area may very well affect nerves in another area. It seems the nervous system may work as a whole and not in just different subsets of entities. When considering this concept it doesn't surprise me that CTS has been shown to also relate to neck disorders. [3,4].

A recent study in JOSPT evaluated this relationship further. The article attempted to analyze if forward head posture (FHP) and cervical range of motion (CROM) is related to CTS or median nerve abnormalities. Subjects with CTS were compared with healthy controls. In addition, subjects were paired based on age, occupation and hand dominance. Occupations consisted of desk worker, housewife, cleaning lady and teachers.

Results indicated a significant correlation to both a reduction in CROM and increased FHP in the group with CTS. CROM differences ranged from 12-18 degrees less in those with CTS. Furthermore FHP ranged with a difference 8-9 degrees in those with CTS.

Although this correlation is an interesting finding it can not create a cause and effect relationship. The study also found these findings to not be related to pain or symptoms of CTS.

In summary, one cannot say CTS is caused by postural abnormalities of the neck. The authors suggest these findings may be due to the CTS itself. A similar example is when patients will often have an antalgic posture when herniating a disc in their back. This purposes the concept that we should explore the option of treating the neck in patients with CTS. Furthermore, if postural corrections are made in patients with FHP will this decrease the prevalence of CTS? Only one case study to date has assessed a multimodal approach to treating a patient with CTS [5]. Hopefully, the following study will promote more research into this relationship.